RESUMO
In this Viewpoint, Donald Berwick explores the pursuit of profit in US health care across sectorssuch as pharmaceutical companies, insurers, hospitals, and physician practicesand its harms to patients, and then offers potential solutions.
Assuntos
Atenção à Saúde , Setor de Assistência à Saúde , Atenção à Saúde/economia , Atenção à Saúde/ética , Atenção à Saúde/estatística & dados numéricos , Reforma dos Serviços de Saúde/economia , Reforma dos Serviços de Saúde/ética , Reforma dos Serviços de Saúde/estatística & dados numéricos , Instalações de Saúde/economia , Instalações de Saúde/ética , Instalações de Saúde/estatística & dados numéricos , Estados Unidos/epidemiologia , Setor de Assistência à Saúde/economia , Setor de Assistência à Saúde/estatística & dados numéricosRESUMO
This Viewpoint offers recommendations to unify various Medicare reform proposals to optimize the health insurance plan.
Assuntos
Medicare , Idoso , Humanos , Medicare/tendências , Estados Unidos , PrevisõesAssuntos
Atenção à Saúde , Pessoal de Saúde , Mão de Obra em Saúde , Saúde , Humanos , Recursos HumanosAssuntos
Pesquisa Biomédica/normas , Lesões Encefálicas Traumáticas/terapia , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/epidemiologia , Cuidadores/estatística & dados numéricos , Efeitos Psicossociais da Doença , Humanos , Liderança , National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division , Vigilância da População , Guias de Prática Clínica como Assunto , Qualidade da Assistência à Saúde , Estados Unidos/epidemiologiaRESUMO
The International Health Regulations-State Party Annual Reporting (IHR-SPAR) index and the Global Health Security Index (GHSI) have been developed to aid in strengthening national capacities for pandemic preparedness. We examined the relationship between country-level rankings on these two indices, along with two additional indices (the Universal Health Coverage Service Coverage Index and World Bank Worldwide Governance Indicator (n = 195)) and compared them to the country-level reported coronavirus disease (COVID-19) cases and deaths (Johns Hopkins University COVID-19 Dashboard) through 17 June 2020. Ordinary least squares regression models were used to compare weekly reported COVID-19 cases and death rates per million in the first 12 weeks of the pandemic between countries classified as low, middle and high ranking on each index while controlling for country socio-demographic information. Countries with higher GHSI and IHR-SPAR index scores experienced fewer reported COVID-19 cases and deaths but only for the first 8 weeks after the country's first case. For the GHSI, this association was further limited to countries with populations below 69.4 million. For both the GHSI and IHR-SPAR, countries with a higher sub-index score in human resources for pandemic preparedness reported fewer COVID-19 cases and deaths in the first 8 weeks after the country's first reported case. The Universal Health Coverage Service Coverage Index and Worldwide Governance Indicator country-level rankings were not associated with COVID-19 outcomes. The associations between GHSI and IHR-SPAR scores and COVID-19 outcomes observed in this study demonstrate that these two indices, although imperfect, may have value, especially in countries with a population under 69.4 million people for the GHSI. Preparedness indices may have value; however, they should continue to be evaluated as policy makers seek to better prepare for future global public health crises.
Assuntos
COVID-19 , Pandemias , Saúde Global , Humanos , Pandemias/prevenção & controle , Saúde Pública , SARS-CoV-2Assuntos
Avaliação de Resultados em Cuidados de Saúde/métodos , Avaliação de Resultados da Assistência ao Paciente , Humanos , Avaliação de Resultados em Cuidados de Saúde/ética , Avaliação de Resultados em Cuidados de Saúde/normas , Assistência Centrada no Paciente , Qualidade da Assistência à SaúdeRESUMO
Donald M. Berwick, MD, MPP, the former CMS administrator who is president emeritus and senior fellow at the Institute for Healthcare Improvement, discusses cost variation in cancer care found through the digital classification system the COTA Nodal Address.